单纯疱疹病毒性角膜炎患者双眼泪液功能改变  

Binocular tear film function changes in herpes simplex keratitis

作　　者：曾庆延[1,2] 蒋华[1] 牛晓光[2] 吴尚操[2] 喻长泰[2] 

机构地区：[1]第二军医大学济南临床医学院(济南军区总医院)眼科,山东省济南市250031 [2]武汉爱尔眼科医院

出　　处：《眼科新进展》2012年第5期467-469,共3页Recent Advances in Ophthalmology

摘　　要：目的观察单纯疱疹病毒性角膜炎(herpes simplex keratitis,HSK)患者双眼泪液量及泪膜稳定性的改变,并通过共焦显微镜观察双眼角膜神经的变化。方法选取2007年1月至2010年1月间我院门诊就诊的HSK患者132例(132眼),对所有患者的双眼进行泪液分泌试验(Schirmer I test,SIt)、泪膜破裂时间(tear break-up time,BUT)及角膜知觉的检查。并通过共焦显微镜对患者角膜上皮下神经和基质神经进行观察。设立相应年龄段的正常人51例51眼为对照组。结果 HSK患者健眼的SIt为(8.80±7.34)mm,明显短于对照组的(17.30±4.13)mm(P=0.013),BUT为(9.60±4.94)s,明显短于对照组的(14.51±5.32)s(P=0.049)。基质型及内皮型HSK患者健眼SIt分别为(4.23±2.79)mm和(4.72±3.93)mm,BUT分别为(8.00±3.89)s和(7.50±4.51)s,均明显低于对照组(均为P<0.05),而上皮型HSK患者健眼SIt为(17.51±4.77)mm,BUT为(13.20±4.88)s,与对照组相比差异均无统计学意义(均为P>0.05)。HSK患者健眼的角膜知觉略低于对照组,但差异无统计学意义(P=0.899)。HSK患者患眼的BUT及角膜知觉均明显少于对照组(P=0.000、0.003),而SIt无明显差异(P=0.498)。HSK患者患眼由于角膜水肿及炎症等因素影响均未看到基质神经干及角膜上皮下神经丛;健眼基质中可见粗大神经干,但上皮下神经丛神经纤维数目较对照组有所减少(P=0.001),而且26.5%的HSK患者健眼神经纤维走行为横向,对照组仅为4.3%。结论 HSK患者患眼及健眼泪液功能均存在不同程度异常,可能与神经调控异常有关。HSK患者在治疗患眼的同时应密切观察健眼的变化,并可预防性应用人工泪液。Objective To evaluate the binocular tear film function changes in herpes simplex keratitis（HSK）,and study the binocular corneal nerves changes by confocal microscope.Methods One hundred and thirty-two HSK patients were enrolled in this study.Binocular tear break-up time（BUT）,SchirmerⅠtest（SIt） value and corneal perception examination were recorded.Binocular corneal subepithelial and stromal nerves were observed by confocal microscope.Fifteen-one Healthy people（51 eyes） with the same age were set as control group.Results SIt and BUT in the normal eyes of HSK patients were（8.80±7.34）mm and（9.60±4.94）s,which were obviously lower than that of control group（17.30±4.13）mm and（14.51±5.32）s,there were statistical difference（P=0.013,0.049）.According to the type of the infected eyes,SIt in the normal eyes of patients with stromal and endothelial type were（4.23±2.79）mm and（4.72± 3.93）mm,BUT were（8.00±3.89） s and（7.50±4.51）s,which were all lower than that of control group（both P0.05）,while SIt and BUT in the normal eyes of patients with epithelial type were（17.51±4.77）mm and（13.20±4.88）s,there was no statistical difference compared with control group（both P0.05）.Corneal perception of the normal eyes in HSK patients were slightly lower than that of control group,but there was no statistical difference（P=0.899）.BUT and corneal perception of the infected eyes in HSK patients were significantly lower than that of control group（P=0.000,P=0.003）,while SIt had no difference（P=0.498）.The nerve in the infected eyes of HSK patients could not be detected because of corneal edema and inflammation.In the normal eyes of HSK patients,thick nerve cord could be detected in the stroma,but the number of subepithelial nerve plexus reduced compared with control group（P=0.001）.Furthermore,in 26.5% of these eyes the directions of the nerve were transversal,while control group was only 4.3%.Conclusion In HSK patients the tear film functions of infected a

关 键 词：单纯疱疹病毒 角膜炎 泪液 角膜知觉检查 角膜神经 

分 类 号：R772.21[医药卫生—眼科]